Nigeria: NaijaLeaks Yar'Adua should have been in a hospice not in office

In a hospice not in office

The drip feeding of WikiLeaks US Embassy cables continues apace with the release yesterday of ones that pertain to Nigeria that have been conveniently named NaijaLeaks.

Two of the cables created in June 2008 and in February 2009 relate to the health of the late president Umaru Musa Yar’Adua who sadly died in May 2010 after a rather secret but prolonged chronic illness.

Whilst it was public knowledge that the President then had serious health problems, the cables reveal the extent to which his health was seriously impaired that he probably should have been between a hospital and a hospice with extensive respite care rather than running Nigeria as Executive President.

Gathering information from various sources, the US Ambassador painted a picture of a man who had “began experiencing symptoms of acute renal failure in late 1999”, was promptly put on dialysis treatment for 3 days a week in the afternoons by his German medical experts and somewhere in 2001 or 2002 received a kidney transplant from the Minister of Agriculture Ruma.

Extremely frail, really ill

His term as the governor of Katsina State commenced in May 1999 and it could be said that from the time he was diagnosed to the time of his demise in May 2010 he probably did not have the requisite recuperation time necessary for a person who had undergone such radical medical procedure and treatment.

Taking a transplanted kidney would have meant that he would be on anti-organ-rejection medication and steroids that would have seriously compromised his immunity leaving him a man of weak health, the result of which included visible facial discolouration.

Further evidence of his weak health was documented by the Ambassador as “she observed him up close, noted that he was extremely frail, more soft spoken than usual, his skin was extremely drawn, teeth were extremely tarred and his involuntary cough had increased”.

“He appeared to weigh no more than 130-140 pounds (63kg max) (which for his height would have left him unhealthily underweight), his skin was very taunt, his handshake was weak, voice was fainter than on previous meetings, his eyes were deep set with dark circles underneath, and his teeth were also very badly tarred”.

Hardly a picture of rude health, one would say; it no doubt affected his ability to govern as his energy levels were very low, he was regularly breathless and he had office hours that ran from 10:00AM to 3:00PM, though, we were given the impression that this was an effective, able and honest governor worthy of assuming greater office in Nigeria.

Healthcare delivery inadequacies in Nigeria

The cables contain the detail which does not need to be repeated in this blog but there are more interesting issues that the cables reveal.

The fact that most Nigerian hospitals bar one were not adequately equipped for the treatment of people with chronic kidney disease, that equipment had to be ordered specially for his treatment and this had to be moved to different locations as his needs warranted.

The fact that his doctors who apparently were specialists were seriously deficient in knowledge and expertise to manage his condition effectively that they had to go abroad for medical courses to bring them up to speed, despite that fact that we have so many university teaching hospitals in the country.

Whilst the source of information could not be corroborated, it was suggested he had lung cancer and foreign specialists were of the opinion that the treatments requiring chemotherapy and the expertise of oncologists was not available in Nigeria to help the president.

The fact that the kidney transplant could only be performed in one hospital in Lagos, Nigeria even if there was adequate secrecy and protection of information about his health to be able to do so.

6 years after the original transplant, that kidney was failing and there were plans to conduct another kidney transplant which should have happened in Nigeria if there were any progress in specialist healthcare development, but there was none and he failed to exploit that opportunity to prevent raising additional fears about his condition.

He should have resigned, retired and refused

In essence, whilst he continued to make appearances he allowed his sharp intellect and mind to work well ahead of his physical and physiological abilities.

A smarter man would have resigned all offices to attend to the important matter of his health but it was observed that his remaining in office albeit as a figurehead allowed for faceless handlers to hold the reins of power and effect official activities in his name, chief amongst whom was his wife.

The reading of the cables casts him as a stooge, the benign face of more sinister and nefarious backroom activities of his clique of confidants who must have persuaded him of the need to remain in office against the advice of his medical staff who would be worthy of being struck off medical practice registers and disgraced if they had not duly warned that he was literally at death’s door.

This leaves one rather perturbed that President Olusegun Obasanjo may not have been aware of how seriously ill this man was before he was tapped to take on the role of presidential successor.

Everyone knew the truth and told a lie

The premier construction company, Julius Berger had been involved in construction of the dialysis units, arranging the installation of the equipment and on many occasions provided the transport President Yar’Adua needed to visit his medical experts abroad.

Royal Dutch Shell in Nigeria was also privy to activities needed to boost the president’s health or at least offer the semblance of healthy ability when in truth that was quite lacking.

It had to have been an open secret in the Federal Executive Council that for all that the man could do, his mind would have been preoccupied with seeing through the next hour talk less of the next day but we never really got a good idea of his incapability until he left for Saudi Arabia in November 2009 and we were informed that he was suffering from acute pericarditis.

In all, the man was at death’s door, retiring from all the pressures of office and the refusing to assent to the greedy entreaties of his wife and the cohort that saw personal gain in propping him up would have brought him back from the brink – if the idea of a sense of duty were proffered, it would have been foolhardy at best and downright recklessly careless.

You cannot short-circuit recuperation

It beggars belief that his wife could have thought that he would be able to run for reelection in 2011, it does take your breath away that she and those others of the “Katsina clique” had none of his interests at heart, along with his evident folly, they and I must include the ex-President pushed the man through death’s door; he suffered an untimely death.

I look at my own circumstances and remember that whilst my mind was way ahead of what my body could do, up to 3 months after chemotherapy I was nowhere near the energy levels required to do everyday things with any efficiency or alacrity.

At 11 months after chemotherapy, my immune system is still building up to what can be termed normal, fatigue still sets in quite frequently and each day, to do something new is a great achievement.

For their own good against his

Umaru Yar’Adua should have left public service in 1999 and taken good care of himself, he should not have sought reelection as governor of Katsina State in 2003 and definitely should have declined the offer to take the office of president when he was being considered in 2006 and selected in 2007.

When he realised he might need another transplant, he should have vacated office, no one is compelled in to stay in office at all costs and definitely when your health is failing and the wise thing was to allow for proper recovery by recusing oneself from unnecessary pressures, especially one as onerous as the office of the President of Nigeria.

In essence we were done a great disservice by the whole governing elite of Nigeria who allowed a very sick man to continue in office against all good judgement. It is a travesty that none of the people involved in this atrocious and disgraceful cover-up have been held to account whilst the foreigners who knew the truth worried about Nigeria’s ineffectiveness in global issues and unbeknownst to us all, we were the world’s laughing stock.

Never ever again

In old-time Russia, even their many comatose presidents never had the global lens focused on them to the extent that it was public knowledge whilst the official bulletins conveyed a lie.

This however calls for a number of legislative corrections to Nigerian politics; the passing of the Freedom of Information Bill; a public record of the medical health of all Nigerian leaders and a radical overhaul of healthcare provision in Nigeria with some attention paid to specialist medical expertise in kidney ailments and cancer treatment.

More importantly, this must never happen again in Nigeria, never ever again.

Sources

Viewing cable 08ABUJA1016, S/NF) NIGERIA

Viewing cable 09ABUJA203, NIGERIA: UPDATED HEALTH INFORMATION ON PRESIDENT

The Cables with interesting parts highlighted

First Cable in 2008

S E C R E T ABUJA 001016

SIPDIS NOFORN

DEPT FOR AF/W, INR/AA, INR/B DOE FOR GPERSON

E.O. 12958: DECL: 06/01/2033 TAGS: PGOV PINR KDEM KISL SOCI NI

SUBJECT: (S/NF) NIGERIA: xxxxxxxxxxxx Ref: a. ABUJA 320 b. ABUJA 799 c. ABUJA 972

Classified By: A/Pol/C Heather Merritt, reasons 1.4 (b, c & d).

¶1. (S//NF) SUMMARY: xxxxxxxxxxxx contended that Yar'Adua began experiencing symptoms of acute renal failure in late 1999, and traveled at that time to Mainz, Germany, to consult with kidney specialists. xxxxxxxxxxxx claimed, that in 1999, German doctors told Yar'Adua to undergo dialysis treatment, and that a dialysis unit was subsequently installed in his private Katsina residence in 2000.

According to xxxxxxxxxxxx when Yar'Adua's condition worsened in 2002, he traveled to Saudi Arabia to receive a kidney transplant. To ensure his body would accept the transplant, Yar'Adua took steroids and other medications which in due course reportedly caused the discoloration that we see today on the President's face. Moreover, xxxxxxxxxxxx averred that Yar'Adua's poor health reduced his capacity to govern and, correspondingly, his political influence in the North.

xxxxxxxxxxxx also alleged that during Yar'Adua's tenure as Katsina governor his wife, Hajiya Turai Yar'Adua, persuaded Yar'Adua to divert millions of dollars of public funds from the Katsina state treasury into private accounts.

(Note: We have heard of similar illicit enrichment attempts by Mrs. Yar'Adua now that she is in the Villa as well as scarce allegations that President Yar'Adua had engaged in corruption while Katsina governor. End Note.)

On the political front, amidst current rumors of President Yar'Adua's failing health, the northern political elite appears increasingly concerned that in the event of Yar'Adua's untimely demise, the presidency may return to the South.

END SUMMARY.

¶2. (S//NF) xxxxxxxxxxxx spoke with PolOff May 26. xxxxxxxxxxxx said that Yar'Adua began experiencing symptoms of acute renal failure in late 1999, after traveling to Jeddah, Saudi Arabia for the lesser pilgrimage in Mecca. Upon returning from Saudi Arabia, xxxxxxxxxxxx claimed, Yar'Adua traveled to Mainz, Germany to consult with kidney experts.

According to xxxxxxxxxxxx the German specialists instructed Yar'Adua to promptly go on dialysis treatment. xxxxxxxxxxxx stated that the German-based Julius Berger construction company, which had significant financial ties to the Yar'Adua family (through the President's elder brother Shehu Yar'Adua), was contracted to set up a dialysis unit in Yar'Adua's home in Katsina.

Doctors from Germany were brought to Katsina to train local physicians in dialysis operations, though, xxxxxxxxxxxx asserted, Yar'Adua also retained the services of German kidney specialists in Wiesbaden, making frequent trips there between 2000 and 2002.

¶3. (S//NF) Following a 2001 visit to Saudi Arabia, xxxxxxxxxxxx said, Yar'Adua's condition worsened, and he was diagnosed with chronic renal failure. Upon returning from Saudi Arabia, Yar'Adua's dialysis treatments become more rigorous, xxxxxxxxxxxx confided, and his dialysis machine was moved into his private bedroom. xxxxxxxxxxxx maintained that Yar'Adua likely received a kidney transplant in Saudi Arabia in either late 2001 or early 2002.

xxxxxxxxxxxx also claimed that Yar'Adua's dialysis machine was removed from his Katsina residence in 2002 and that discoloration was evident on his face at that time, which he assessed was the result of Yar'Adua taking steroids and other medications to enable his body to accept a transplant. xxxxxxxxxxxx rejected notions Yar'Adua suffered from Churgg-Strauss syndrome.

Additionally, xxxxxxxxxxxx explained that the raised patch of skin often noted by observers on President Yar'Adua's right hand is not connected to his kidney ailments, but instead the result of a serious car accident Yar'Adua sustained in 1999. According to xxxxxxxxxxxx after Yar'Adua's car accident, his physicians removed some tissue from his buttock area to graft to his injured, and badly disfigured hand.

Abuja 00001016 002 of 003

¶4. (S//NF) xxxxxxxxxxxx contended that Yar'Adua "always" craved power, dating back to the days when Yar'Adua first contested and lost the governorship of Katsina state in 1991. Indeed, xxxxxxxxxxxx remarked, Yar'Adua's politically prominent family "bred" him to assume office in the future.

However, xxxxxxxxxxxx asserted that throughout Yar'Adua's administration in Katsina, his performance suffered due to his poor health, which contributed to his constant fatigue, and to "an inability to govern." Whereas Katsina state commissioners and permanent secretaries routinely worked twelve-hour days, xxxxxxxxxxxx said that governor Yar'Adua himself entered the office at 10:00am and returned home around 3:00pm each day.

According to xxxxxxxxxxxx Yar'Adua seemed disinterested in engaging in the requisite politicking that is the hallmark of political relations between elected leaders and power brokers in the North, and Nigeria generally. Yar'Adua's disinclination to travel while governor, even to neighboring states to meet with the northern political elite, also perpetuated his political isolation.

¶5. (S//NF) During his tenure as governor of Katsina, xxxxxxxxxxxx maintained, Yar'Adua appeared deliberative and ruthless in managing the affairs of his state. While intelligent, Yar'Adua, according to xxxxxxxxxxxx neither tolerated disagreement nor insubordination. xxxxxxxxxxxx noted that Yar'Adua ultimately relied on a handful of confidants, whom xxxxxxxxxxxx considered sycophants more than dispassionate consultants.

xxxxxxxxxxxx said that Yar'Adua, paradoxically, routinely ignored the counsel of even his purportedly trusted advisers, preferring instead, to make his own decisions. In so doing, xxxxxxxxxxxx said, Yar'Adua had been assessed by some other northern elders as both an unimpressive leader, and an irresponsible one.

¶6. (S//NF) xxxxxxxxxxxx suggested that while Yar'Adua served as governor of Katsina, Yar'Adua's wife Hajiya Turai Yar'Adua, manipulated him into diverting millions of dollars of funds from the state treasury into private Yar'Adua family accounts. xxxxxxxxxxxx alleged that Yar'Adua used these stolen funds to construct a lavish private residence in Katsina and to finance family vacations to the Middle East and the UK (Ref A).

Though xxxxxxxxxxxx acknowledged that Yar'Adua as former governor had built primary and secondary schools in Katsina, xxxxxxxxxxxx criticized Yar'Adua for failing to properly fund the training of teachers for those schools. As a result, xxxxxxxxxxxxx said, unlike in the past, under Yar'Adua's two terms as governor, Katsina students consistently failed to meet national standards in math and reading assessments. xxxxxxxxxxxx said that for Yar'Adua, "it was all about the spectacle of governing."

Even the roadways in Katsina, xxxxxxxxxxxx said, may have been impressive, particularly when compared to the deplorable road network in other parts of the North, however, xxxxxxxxxxxx alleged that while the roads had been built, the contract costs were egregiously inflated and the excess funds were siphoned. xxxxxxxxxxxx said some Katsina road contracts had been given to non-existent, "ghost" companies, which were secretly "owned" by Turai Yar'Adua.

¶7. (S//NF) COMMENT: xxxxxxxxxxxx allegations of Turai Yar'Adua's contract-related corruption in Katsina also seem credible in light of similar claims previously reported by the Mission since she became the First Lady (see Ref A, for example). xxxxxxxxxxxx perspective may help shed light on President Yar'Adua. As reported (Ref C), we believe the President has two sides: one, for international consumption; and the other, which turns a blind eye to certain rule of law issues, particularly as it pertains to his wife.

Then-governor Yar'Adua's unwillingness to engage in the necessary politicking to build a broad base of support in Katsina may have been relatively insignificant against the backdrop of insular Katsina state, or even northern regional, politics. However, as president of a diverse nation, with competing regional interests and powerful patronage networks, Yar'Adua's continued political isolation (even within the North) may illustrate, to an extent, why even today Yar'Adua has not fully succeeded in truly stamping his authority on the PDP or the Presidency.

¶8. (S//NF) COMMENT CONT'D: Certainly, Yar'Adua's health remains a cause of concern for northern power brokers, especially in light of the possibility that Vice President Goodluck Jonathan would constitutionally be next in line for the presidency in the event of Yar'Adua's demise, although we doubt the northern elite would allow this to transpire.

Opposition presidential aspirant Muhammadu Buhari (All Nigeria People's Party) told PolOff May 13 at his Kaduna home that given the North's trepidation of power returning to the South (if, for instance, Yar'Adua cannot complete his term), Buhari feels vindicated in his insistence on challenging the President's election.

Buhari intimated that members of the northern political elite have begun visiting him to affirm their allegiance to him, and to support him as he continues to contest Yar'Adua's election at the Supreme Court (see Ref B). Buhari noted that, in light of news of Yar'Adua's troubling health, some northern power brokers now believe fresh polls (wherein Buhari emerges the victor) might be the best way of ensuring that the North retains the presidency.

End comment.

¶9. (S//NF) xxxxxxxxxxxx END NOTE. Sanders

Second Cable in 2008

S E C R E T 09ABUJA203

NOFORN SIPDIS

DEPT FOR AF/W, INR/AA DOE FOR GEORGE PERSON

E.O. 12958: DECL: 01/26/2034 TAGS: PGOV PREL PINR NI

SUBJECT: NIGERIA: UPDATED HEALTH INFORMATION ON PRESIDENT YAR'ADUA (C-AL8-02520)

REF: A. STATE 6401 ¶B. 08 ABUJA 2525 ¶C. 08 ABUJA 2517 ¶D. 08 ABUJA 2222 ¶E. 08 ABUJA 2165 ¶F. 08 ABUJA 2147 ¶G. 08 ABUJA 2141 ¶H. 08 ABUJA 2123 ¶I. 08 ABUJA 2104 ¶J. 08 ABUJA 2065 ¶K. 08 ABUJA 1822 ¶L. 08 ABUJA 1016 ¶M. 08 ABUJA 962

Classified By: Ambassador Robin Renee Sanders for reasons 1.4. (b & d).

¶1. (S/NF) INTRODUCTION.

Ref A requested updated information about the health of Nigerian President Umaru Musa Yar'Adua. We note that our GON and private contacts continue to state that President Yar'Adua is managing his known health issues -- chronic kidney problems -- and is not suffering from something more serious.

The Villa also continues to keep a tight hold on any information concerning his health and has been cautious about any indications on travel outside of Nigeria, to avoid additional concerns. As a result, attempts to gain specific and/or verifiable information on his condition, prognoses, medication, treatment options are limited.

The Ambassador's last personal dialogue with him (Ref. C), in which she observed him up close, noted that he was extremely frail, more soft spoken than usual, his skin was extremely drawn, teeth were extremely tarred and his involuntary cough had increased.

He was, however alert and could carry on a sophisticated conversation. We have also reported, ref. B, recent extensive critical comments by a Villa staff member on the impact of the President's health on the country's governance. What is clear is that the President's health is a matter of growing concern, particularly on the minds of the northern Nigerian elite.

We have noted a considerable up-tick in what appears to be behind-the-scenes machinations and backroom dealing, most notably the recent reconciliation meeting between former President Obasanjo and former VP Atiku and Atiku's pending official return in March to the ruling PDP, former President Babangida's sudden return to the political scene with a string of public pronouncements, and Kwara Governor Saraki's machinations to possibly be a PDP candidate in 2011.

¶2. (S/NF) If Yar'Adua were closer to "death's door," we would expect more of a political power struggle publicly to break out drawing in these traditional "Godfathers" of Nigerian politics, as well as newer groupings including Kwara State Governor Saraki (and Governors' Forum chairman), some of the other Governors (e.g. Niger and Kaduna), and some members of the "Katsina clique" who have gathered around Yar'Adua.

All these groups have a shared interest either in maneuvering VP Goodluck Jonathan out of assuming the presidency, or in assuring that his power as President was strictly circumscribed and that he appointed a strong Northerner as his VP. (We note there has been a speculation of a Yar'Adua demise in February 2009.

Thus, this has not happened and he may either not be suffering from a terminal disease or could -- as other leaders have done in the past -- hang on longer than we anticipate.)

¶3. (S/NF) Yar'Adua began a two-week vacation on January 26 (to date he still remains in Abuja and his vacation is scheduled to end on Monday, February 9). However, official statements from the Presidential Spokesman indicated that he would pass the two weeks in Lagos, Cross River State (at the Obudu Cattle Ranch) and at his home state of Katsina.

There is widespread speculation, however, that the Villa may be using the guise of a "vacation" to hide medical treatment. On January 27, Kwara State Governor Saraki insisted to Ambassador that Yar'Adua will not/not leave Nigeria during his vacation; however, we believe that he is most likely receiving clandestine medical treatment in Nigeria during this period.

Ambassador was told by two key contacts, Shell VP for Africa on January 27 and Information Minister Akunyili on February 2, that experts from Germany have been brought in to oversee the President's treatment.

END INTRODUCTION.

¶4. (S/NF) Information below on the health of President Yar'Adua is keyed to Ref. A questions:

¶A. (c) overall health

A 1. (S/NF) DIAGNOSES: Despite continued statements by the Villa spokesperson that the President is not in poor health, several individuals xxxxxxxxxxxx and First Lady Turai Yar'Adua) have admitted privately to the Ambassador that he suffers from acute kidney disease (Refs. C, G, H and others).

We continue to hear press and blog reports that Yar'Adua suffers from lung cancer, although this is generally from sources further removed from the Presidency. xxxxxxxxxxxx is the only credible source who confirmed that he heard reports of lung cancer. xxxxxxxxxxxx is not close to the President and has access to tertiary information at best.)

On October 27, First Lady Turai Yar'Adua told Ambassador that Yar'Adua did not have lung cancer, but admitted that he suffered from long-term kidney disease and from asthma (Ref. G). On January 27, Kwara State Governor Saraki, a medical doctor by training, told Ambassador that Yar'Adua is "not at death's door" and that he is learning to cope and manage his energy levels better, leading to an improvement in his energy and breathing since the September 2008 timeframe.

xxxxxxxxxxxx a contact xxxxxxxxxxxx at the German Julius Berger company said that Yar'Adua is steadily weakening and going downhill, noting that although he is "not in danger of dying soon," his ailments were serious and chronic. Other media outlets, such as the online news site "Sahara Reporters" have reported several conditions: Churg Strauss Syndrome and/or lung cancer along with kidney disease.

In a follow-up meeting with Information Minister Akunyili on February 2, xxxxxxxxxxxx told the Ambassador that Yar'Adua remained extremely weak. xxxxxxxxxxxxx noted that when xxxxxxxxxxxx last met with him it was at the residence and not the office as he has substantially reduced his office hours to conserve his energy.

xxxxxxxxxxxx said Yar'Adua told xxxxxxxxxxxx that he really wanted to go out of Nigeria for "a rest" but given the uproar over his September 2008 trip to Saudi, he was compelled to stay in Nigeria to avoid more speculation on his health. xxxxxxxxxxxx added that Yar'Adua's current strategy is to have meetings planned well in advance so he can rest up in order to be able to have enough energy to complete the session.

xxxxxxxxxxxx

A 2. (C) PAIN:

Most of Post's information concerns his lack of energy and fatigue; however, information exists in other channels regarding pain management.

A 3. (s/nf) health improved/worsened, changes in appearance: We believe that Yar'Adua still remains weak and as physically fragile as he was in November-December 2008. Ref. C contains Ambassador's observations during her meeting with Yar'Adua on the margins of the December 19, 2008 ECOWAS meetings.

Ambassador noted: he coughed more extensively as he delivered his speech on becoming ECOWAS Chair, he appeared to weigh no more than 130-140 pounds, his skin was very taunt, his handshake was weak, voice was fainter than on previous meetings, his eyes were deep set with dark circles underneath, and his teeth were also very badly tarred.

Over the past several weeks, Yar'Adua has made few public appearances. Despite this, he was able to carry on a sophisticated conversation. His most recent appearance was at his daughter's marriage on January 25, 2008, to Bauchi State Governor Yuguda. Although we believe these appearances were meant to calm public anxiety, they actually tended to renew suspicions about his health.

Based on pictures and TV coverage of these events he appears pale and weak. He continues to lose weight and he coughs and appears at times to have difficulty breathing when he talks. U.K. diplomats told us January 28 that they have seen reports that Yar'Adua wears make-up for public appearances and padding to hide his weight loss.

A 4. (S/NF) RESTRICTIONS TO ACTIVITY/SCHEDULE: Yar'Adua's schedule, since assuming office in May 2007, has never included long days or late night appointments (Ref. M); however, it has clearly been severely restricted since late Summer and appears to be more so since late December 2008.

President Yar'Adua has made few international trips since assuming office, including missing the September 2008 UN General Assembly meetings. xxxxxxxxxxxx contact of the Mission shared his risk-analysis paper with us in late 2008 (Ref. B, q.v.), in which he complained that Yar'Adua's restricted office hours are "taking a heavy toll on governance."

He also noted then that the President "works for limited hours, often can't keep scheduled appointments, and cannot undertake rigorous national tours." On xxxxxxxxxxxx told PolCouns that Yar'Adua's health has improved "a bit" since last fall; however, there has been no positive impact on his ability to meet the demands of the presidency. (This comment dove tails with Saraki's, who also indicated that Yar'Adua has had a slight improvement.)

A 5. (s/nf) Yar'adua aware of his diagnoses/prognoses: Although the spokesman for the Villa continues to maintain that Yar'Adua has no serious health problems that hinder his ability to carry out his executive functions, the President's wife admitted his serious kidney ailment to the Ambassador.

We do believe that those around him may be jeopardizing his well-being for their own political gain. We note that, in conversations with other foreign diplomats, the First Lady has indicated she is looking forward to Yar'Adua running for a second term in 2011.

A 6. (C) NAMES AND SPECIALTIES OF PHYSICIANS: Adamu Banye Barau serves as Chief Physician to the President. Barau applied for a U.S. visa in April 2008. xxxxxxxxxxxx Barau planned to travel to the U.S. to purchase medical equipment. In addition, we know Hussaini Yakasai Munir serves as a Villa medical officer.

(NOTE: Munir applied for a visa in mid-January to attend medical training in North Carolina from February 2-14. Specifically, he will attend Advanced Cardiac Life Support, Cardiac Stress Testing, Overview of Cardiac Catheterization, Non-Invasive Management of Myocardial Infarction, and Advances of Echocardiography at Ladan Medical Center, North Carolina under Dr. Mohammad Lawal Garba.) We also know from several sources that German specialists do come in and out of Nigeria as they are, xxxxxxxxxxxx, transported by the German Julius Berger company.

A 7-8. (c) who provides Yar'adua with reports on health and IS HE FOLLOWING DOCTOR'S ADVICE: We have no specific information, but we believe that his wife and other members of the "Katsina clique," such as Agriculture Minister Ruma, and possibly Kwara Governor Saraki (who is a medical doctor), are managing Yar'Adua's health strictly for political reasons, which seems to overshadow any advice he may be receiving from medical experts.

¶B. Procedures and treatments

B 1. (C) MEDICATIONS AND CHANGES IN MEDICATION: Information exists in other channels that provides suggestions on what Yar'Adua may be taking.

B 2. (s/nf) medical procedures/surgeries in the past year: Yar'Adua had a range of medical tests in Saudi Arabia in late August 2008, about which there is reporting in other channels. According to Leadership newspaper, between August 20 and August 31, 2008 he was at the King Abdulaziz Hospital in Jeddah.

We understand that, in 2001 or 2002, while he was Governor of Katsina State, Yar'Adua had a kidney transplant. The Ambassador was told on November 1, 2008 that Minister of Agriculture Ruma was the donor for Yar'Adua's transplant, but that the kidney now appeared to be failing. The individuals (lunch attendees at a Central Bank luncheon) maintained that Ruma's brother had traveled to Germany to determine if he was a potential match for a second transplant (Ref. E).

B 3. (C) ADVISED TO SEEK TREATMENT IN LAST MONTH: We understand that travel to Germany was being heavily considered by the Villa in December 2008, but given that it sparked renewed public concern about Yar'Adua's ability to govern, the President remained in Nigeria. This has been confirmed by xxxxxxxxxxxx

B 4. (S/NF) CANCELED OR POSTPONED ANY PLANNED TREATMENT:xxxxxxxxxxxx told Ambassador on December 22 that First Lady Turai Yar'Adua confided xxxxxxxxxxxx that Yar'Adua would travel to Germany for a second renal transplant between December 16 and January 1 (Ref. C).

Yar'Adua did not take this planned trip given public reaction to rumors about travel and concerns about his ability to govern. We have no information on whether this trip may be rescheduled.

¶C. Medical equipment

C 1. (C) EQUIPMENT ACCESSIBLE IN ABUJA: We understand that the Villa maintains a dialysis machine for the President's use in Abuja and from a credible source at Shell Oil Company that some additional medical equipment for the President arrived in December-January 2009. xxxxxxxxxxxx was more specific in a xxxxxxxxxxxx meeting with Ambassador, saying that Yar'Adua is on dialysis three times a week in the afternoons.

C 2. (s/nf) access to equipment to treat lung cancer: U.S. medical personnel operating in Nigeria believe it may be possible to bring chemotherapy drugs into Nigeria to receive chemotherapy; however, the only hospital which may/may have radiation equipment is Lagos Teaching Hospital.

In all, however, the American physician with whom we spoke on January 29 noted that both chemo and radiation therapy require a large cadre of trained specialists (from oncologists, to nurses and equipment technicians). However, Nigeria has little to no specialists in these areas. Due to the lack of local specialists, our medical source believed it would not be possible to receive reasonably adequate treatment in Nigeria.

C 3. (s/nf) access to equipment for surgery related to renal FAILURE OR LUNG CANCER: St. Nicholas Hospital in Lagos recently began performing minimally invasive transplants (including both removal -- important as all donors in Nigeria are "living donors" -- and transplantation) using equipment from South Africa.

C 4. (S/NF) NEW MEDICAL EQUIPMENT BROUGHT TO ABUJA: Press reports have circulated periodically that new equipment was being purchased (dialysis machines mainly) and online news site Sahara Reporters reported on January 22 that a contract had been awarded previously to one of Yar'Adua's brothers to build a 10 billion Naira ($64 million) "State House Clinic" at the Villa (advertised in the SUN newspaper on July 5, 2008).

Sahara Reporters maintained that the clinic was never completed, but that dialysis equipment and equipment for a complete Intensive Care Unit (ICU) was purchased. As noted in A6 above, Chief Physician to the President Amadu Barau is believed to have traveled to the U.S. in May 2008 to purchase medical equipment. The specific type of equipment is unknown.

C 5. (s/nf) surgical equipment and specialists in Nigeria to PERFORM KIDNEY TRANSPLANTS: The St. Nicholas Hospital in Lagos has a full transplant team. St. Nicholas has been performing renal transplants for approximately ten years, performing more than 80 of the 100 or so transplants that have been done in Nigeria.

To date, there remains no capacity in Nigeria to do HLA (human leukocyte antigen) tissue matching, although samples can be taken in Nigeria and sent abroad for testing.

¶D. Mental health

D 1. (s/nf) does Yar'adua seem sad, detached, distracted, IRRITABLE OR CONFUSED: xxxxxxxxxxxx both reported to Ambassador in December that the President was exhausted, but still very intellectually competent, and that the political haggling and pressure of putting together a new cabinet drove him to push for a vacation outside of Nigeria.

The political pressures of the cabinet reshuffle reportedly took a further toll on his physical wellness. At Ambassador's last meeting with him, he did not seem sad, detached, irritable or confused.

D 2. (s/nf) does Yar'adua conduct meetings/ is he alert and FOCUSED: Yar'Adua has delivered remarks recently at the January 12 Armed Forces Remembrance Day and the January 16 presentation of the 2006 Census to the National Assembly, as well as attended the highly visible wedding of his daughter to Bauchi Governor Yuguda on January 24. In these public appearances, he appeared physically fragile.

Ambassador noted in her December 19 discussions with Yar'Adua and observations of him at ECOWAS that he "remained focused and still showed intelligence, understanding and awareness in his dialogue." Others, from the Foreign, Petroleum and Information Ministers to the Central Bank Governor, have confirmed the same.

D 3. (s/nf) does Yar'adua use prepared notes/ do aides prompt HIM OR ANSWER FOR HIM: Yar'Adua spoke at the January 12 Remembrance Day events in Abuja without notes. In his December 19 interactions with Ambassador, he spoke without notes and without prompting from aides. We believe that he is still intellectually fit, even if we don't agree with his style of governance.

However, his physical weakness adds to the inability of his administration to do more on top of his slow leadership style. We judge that even if his health were not an issue, his governance and leadership style would likely remain slow and largely ineffective as a result of his personality, his lack of a political network of his own, and the fact that he chooses not to dictate decisions to his Ministers, even when necessary and/or expected.

Although he may not be up for days beforehand, he still chairs his weekly Cabinet meetings, which we still understand can run 3-4 hours.

¶E. Spread of health information

E 1. (s/nf) why are Yar'adua/family/advisors reluctant to DISCLOSE HEALTH INFORMATION: While we have heard the argument that Yar'Adua's quiet personality and his northern Nigerian culture are the reasons for his unwillingness to discuss health information, we believe that those close to him are motivated more by a desire to retain power.

His wife and several special advisors, such as Economic Advisor Tanimu Yakubu, we would put high on this list as they only have influence so long as he is President.

E 2.xxxxxxxxxxxx stage is missed. (This is a point the Mission raises regularly with GON interlocutors.)

E 3. (c) Reasons or motivations for those close to Yar'adua TO LIE ABOUT HIS HEALTH: We would characterize the behavior of those close to Yar'Adua more as avoidance, secrecy and disregard for what is ultimately medically best for the Nigerian President. We would add that the closed-mouth nature of both Yar'Adua and his wife, plus the influence of their religion are also factors.

In Yar'Adua's May 15, 2008 interview with the Financial Times, he admitted he is "a normal human being, who can fall sick," hinting at his medical condition. His wife admitted his kidney and asthma ailments to the Ambassador on October 27, 2008 without hesitation. So, his handlers do not directly lie, but just go to great lengths to avoid talking about it.

#. (U) This cable was coordinated with Consulate Lagos. SANDERS